Cost Effectiveness of Pegaptanib for the Treatment of Age-Related Macular Degeneration in the UK

Abstract

The results suggest that pegaptanib treatment is likely to be cost effective across all groups studied, and marginally more cost effective in younger patients and those with better pre-treatment VA. Cost effectiveness appears to be optimised if treatment is discontinued after 1 year if individual patients' VA has dropped by > or =6 lines from pre-treatment levels, or at any time if it drops below 6/95. However, strict application of discontinuation rules does not appear to be necessary for pegaptanib to be cost effective. Clinical judgement and patient preference should be an important determinant in decisions about stopping treatment.

Cost Effectiveness of Treatments for Wet Age-Related Macular Degeneration

“…d30 000 or $US50 000 per QALY gained); [2,24,27,37] a fifth study in the US showed that ranibizumab was dominant over usual care when caregiver costs were taken into account, but not cost effective when caregiver costs were excluded. [26] Of five pegaptanib studies, one UK analysis found pegaptanib to be clearly cost effective versus best supportive care over a 10-year time horizon; [23] the other four studies (including a UK HTA) showed that the cost effectiveness of pegaptanib varied considerably depending on the stage of disease and time horizon. [2,11,21,22] Nine studies provided cost-utility analyses of PDT with verteporfin compared with no treatment, usual care or best supportive care, reflecting that this is an older treatment option for wet AMD.…”

“…A UK-based analysis by Wolowacz et al [23] showed treatment with pegaptanib to be cost effective relative to best supportive care for subfoveal wet AMD over a 10-year timeframe from a governmental perspective; ICERs were lower when visual acuity at treatment initiation was better. However, an HTA by Colquitt et al [2] calculated higher costs per QALY gained over the same timeframe and from a similar perspective.…”

“…[32] Incremental costs per vision-year gained varied widely, ranging from d2696 from a governmental perspective in the UK [23] for all types of wet AMD, to $US57 230 from a third-party payer perspective (for late subfoveal CNV). [22] …”

Current Status of Vascular Endothelial Growth Factor Inhibition in Age-Related Macular Degeneration

“…Efficacy and safety analyses were recently reported in two randomized, sham-controlled, clinical trials. [25,26] The two combined trials, known as the VISION (VEGF Inhibition Study in Ocular Neovascularisation) study, enrolled 1186 patients. Patients received either an intraocular injection of pegaptanib or a similar sham injection every 6 weeks.…”

“…Visual acuity (VA) was measured using Snellen eye charts, during which patients were asked to identify specific sized letters or lines at a set distance. [25,26] The VISION study demonstrated a significant difference in loss of VA by 1 year in patients who received pegaptanib as compared with those who received sham injection (a loss of 7.93 letters for pegaptanib vs 15.05 letters for sham; p < 0.0001), which was maintained at 2 years. [25,26] The risk of severe loss of VA (loss of 30 letters or more) from baseline was 22% in the sham-injection group and 10% in the pegaptanib group (p < 0.001).…”